Tunnelling Versus Non-tunnelling Techniques in Posterior-based Buccinator Myomucosal Flap Reconstruction - A Prospective Study.

INTRODUCTION: The posterior-based buccinator myomucosal flap is a reliable option for reconstructing posterior oral defects, though pedicle transfer methods vary. This prospective study compared functional outcomes, complications and burden of care between tunnelling and non-tunnelling techniques. MATERIALS AND METHODS: Patients were randomised into Group A (tunnelling, n = 20; single-stage) and Group B (non-tunnelling, n = 20; two-stage). Primary outcomes were flap survival and need for secondary surgery. Secondary outcomes included trismus, oral opening and mobility. Data were analysed using independent t-tests and Fisher's exact test. RESULTS: Flap survival was comparable (95% vs. 100%, P = 1.000). However, the non-tunnelling group required a second surgery and had significantly longer hospital stays (4.0 vs. 2.0 days; P = 0.002). At 6 months, the tunnelling group achieved substantially greater maximum oral opening (39 mm vs. 33 mm, P = 0.008), despite higher rates of venous congestion (25% vs. 5%) and trismus (15% vs. 5%). DISCUSSION: The tunnelling technique is superior for operative efficiency, offering a single-stage reconstruction that avoids the morbidity and cost of a second operation. While simpler initially, the non-tunnelling technique necessitates a second stage and results in greater long-term limitation of mouth opening.